Make It Last – Ep 82 – Developing Your Team & Interview with Dr. Apter of Princeton Medical Institute

Make It Last – Ep 82 – Developing Your Team & Interview with Dr. Apter of Princeton Medical Institute

Seeing those you have not seen in a while can draw attention to issues you may not have realized were developing in older adults in your family. After the holidays is a great time to begin to develop a team of professionals to assist your family in getting older adults to a safe and comfortable place in their lives as they continue to age. Listen to the first segment of the show as I describe a few good places to start when developing your team.

In the second segment of the show I interviewed Dr. Apter of Princeton Medical Institute. We discussed the clinical trials Dr. Apter has been providing to those with Alzheimer’s, which aid in finding effective solutions to those living with the disease.

Make It Last with Victor Medina is hosted by Victor J. Medina, an estate planning and Certified Elder Law Attorney (CELA®) and Certified Financial Planner™ professional (CFP). Through his law firm and independent registered investment advisory company, Victor provides 360º Wealth Protection Strategies for individuals in or nearing retirement.

Victor J. Medina: Hey, everybody welcome back to Make It Last. I’m your host, Victor Medina. I’m so glad you can join us today. I’m really excited about today’s show because got a special guest here, and his name is Dr. Jeff Apter. Dr. Apter is the founder of the Princeton Medical Institute, and he’ll introduce himself when he comes on for the interview segment.

You’ll see he is a practicing psychiatrist, but over the last 30 years has put together an organization that, right now, is focusing on a number of clinical trials that are available for trying to find an effective solution for people that are suffering from Alzheimer’s.

This interview was pre‑recorded. Dr. Apter’s quite a busy man, but you’ll hear him mention in there how Alzheimer’s really is the plague of the 21st century, how we’ve been able to address things like malaria and the plague itself, but this is something that’s so rampant and for which there’s no effective treatment. More and more people are being diagnosed with it and suffering from it.

We’re all aware of the Alzheimer’s Association. It exists. There are caregiver associations. Nothing seems to rob someone away more than Alzheimer’s and the families that are affected by that. I’m excited to bring to you today Dr. Apter and some of what he’s sharing in the advances in clinical trials, what’s on the horizon and how you can get involved.

I know there are more and more people that are listeners, both as the baby boomer generation just ages and we’ve got more of them getting older, we’ve got so many people coming into our office that are right there, suffering from dementia in some format. I’m real excited to bring him here.

This is right after Thanksgiving. Before [laughs] I get too far and deep into the subset, I hope you had a wonderful Thanksgiving. I noticed something that happens in our office, which is Thanksgiving ends up being an opportunity for people to gather their families around.

One of the weird consequences of that is that people finally open their eyes to what’s going on with a family member at risk. An older adult, a parent, especially, might be dealing with dementia, cognitive decline or just might be in a living situation where they’re just not thriving.

When families come together for Thanksgiving, it is the first opportunity for everyone to gather for people that are not around there normally. It is just like the principal points of contact for that parent, to see what’s going on.

They may have only been hearing about it over the phone. It’s when they get in front of that person that they get to see what’s going on and how bad it might actually be.

When I say, “The weird thing that happens in my office,” is we’re able to see the Web traffic about people that come to our website. It used to be that the day after a holiday we would see a huge uptick in Web traffic, but nowadays everyone’s got a phone. That phone is connected to the Web and we see it on Thanksgiving, on Christmas, on New Year’s Day.

Any times that families gather, we see a huge uptick because people see what’s going on and then they start searching out for some form of a solution. What I want to do is spend a little time talking you through the resources that are available.

If you were in a situation recently at Thanksgiving and you noticed that there’s something going on, but you’re not really sure quite what, yet. You may be a little lost for what to do about it.

One of the things that you can do is reach out to a series of resources that are available and start to collect a team. I go over this a little bit in the book that I recently published called, “Make It Last ‑‑ Protecting Your Family Against the Costs of Aging.” There’s a chapter in there about gathering your team, but for right now you should focus on two team members as who you bring on first.

It’s not going to, at all, surprise you that I think you should bring on an elder law attorney. Specifically, a certified elder law attorney. The reason for that is that a certified elder law attorney has got special training or they’ve passed special exams and qualifications to really be focusing in the area of planning for seniors and elders, but not just in the document creation.

They are there with expertise in handling housing situations, incapacity planning, different benefits planning, insurance, financial stuff. It’s import because they have that broad base of knowledge to come up with practical solutions facing the challenges of our seniors.

In addition to that, to passing all of the substantive knowledge that they have to have, they’re also there having demonstrated that they’ve handled a certain number of cases. They already have the experience in the area. It’s not just academic knowledge in there, but there’s also practical knowledge.

Your first step is to reach out to a certified elder law attorney. You can find one in your area, no matter where you are listening to this, by going to nelf.org. N‑E‑L‑F, that stands for the National Elder Law Foundation, nelf.org. If you go there, you’ll be able to search for a CELA, a Certified Elder Law Attorney, in your area.

I’m one, but I will tell you that New Jersey is chock‑full of them. It has the highest number of CELAs in the country. If you are a New Jersey listener, if it’s not us that you’re going to come and visit, you will be able to find somebody that can help you with that.

In addition to that, I recommend contacting a geriatric care manager or a GCM. Geriatric care manager, the best ones are people who can make assessments globally on the non‑financial, non‑legal stuff. The CELA is going to be there to be able to take a look and say, “OK, this is how your documents, your finances, and our recommendation on how to put yourself in the best position.”

The geriatric care manager is going to look at everything else. They’re going to be able to see the home situation. There’s many times they are social workers or they’re nurses.

They’re going to be able to take a look at everything that’s going on ‑‑ medications, living situation, interviewing the person to see how they react, and use a combination of the information that they learned and their experience, to come up with a set of recommendations.

A number of sessions ago, on the show I had Mary Kay Krokowski from Aging Advisors on there. She is an outstanding geriatric care manager. One of the things that we look for in somebody that is going to be performing geriatric care management services, is you really want somebody that’s independent from a home health care agency.

You have to be careful here because there are a lot of home health care agencies that’ll make an assessment about whether or not you need a home health care aide, but remember that they have this other business that they’re selling, too.

It won’t at all surprise you when they’re making recommendations that you should hire them for this other component of it. You want somebody that’s completely independent. An organization like Aging Advisors or other geriatric care managers that are just geriatric care managers. They don’t sell home health care agency services.

In addition to that, will be able to give you an independent view of that. You want somebody that’s agnostic. You’ve heard me on the show. I don’t know how many times mentioned the word fiduciary, because that’s somebody that’s working in your best interest, that doesn’t have the conflicts of interest about what they’re recommending.

This is the same case in a geriatric care management scenario as well. What you’re doing is essentially working with, somebody that’s going to be in a scenario that is going to make independent recommendations, that they can stand on their own. There’s nothing in it for them. All they want is the best for what’s in the client.

If you start to gets together a team that’s made up of a certified elder law attorney and a geriatric care manager, you’ll be able to get a better complete picture about what’s going on. You’ll be able to work with this team together, and be able to chart a course forward that will bring this person who’s at risk to a better situation.

They might make a recommendations about how to normalize their medication. They might make recommendations about how to organize their finances and prepare for a road that could possibly stand on landmines if they needed different kinds of care.

The certified elder law attorney’s going to be able to give you a different look on how to marshal everything that you have, and really set things up for the best case scenario, depending on what life is going to throw at them along the way.

With great certified elder law attorneys and great geriatric care managers, they’re involving everybody in the family. Everyone comes together for that. They get all of the information so that you’re making decisions as a family unit. We’re especially blessed ‑‑ the Medina Law Group ‑‑ that we work with great families that are looking out for their parents’ best interests.

All they want to do is make sure that mom or dad are better for having started down this road. They’re just looking for those solutions.

If you start to put that kind of team together, you may have a specific home health care aide that’s part of the team because they’re going to observe what’s going on. You might bring in a neurologist or specific medical professional because that’s the disease state that they’re facing.

You might add to the team, but if you start with the basis of a certified elder law attorney and a geriatric care manager, that together is how you begin to put together a great team that’s going to help this person that’s at risk.

I hope that’s not going on for you and your family, but if it is and it does happen a lot, if you’ve just come back from Thanksgiving and you’ve noticed that there is something to do, beginning to put together your elder care team is going to be something good.

Remember, if you need more resources on that, the book is available for purchase on Amazon. It’s called Make It Last ‑‑ Protecting Your Family Against the Cost of Aging. It’s available on Kindle. That’s just 10 bucks for that. It’ll give you an enormous level of resources and education for it.

If you were ever to reach out to our office, we’d be happy to send you a copy if you’re making an appointment to come in and see us.

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Victor: That’s enough for that. Coming back from the break I’m going to have Dr. Apter with us. He’s going to share this incredible information about what’s available in clinical trials in the Princeton Medical Institute. Stick with us. We’ll be right back after this quick break.

Victor: All right, welcome back to Make It Last. My guest today is Dr. Jeff Apter. Would you call yourself the founder of the Princeton Medical Institute? What’s your role with that?

Dr. Jeff Apter: I am the founder of Princeton Medical Institute. I started out as a psychiatrist in private practice. Eventually, I started to do some clinical trials and got involved in some of the early trials approving drugs for depression, such as the serotonin reuptake inhibitors and some of the newer drugs for Alzheimer’s disease such as Exelon and Aricept.

We started the institute about 30 years ago. We’ve gradually been involved in more and more clinical trials. I am the medical director at Princeton Medical Institute. I oversee all the clinical trials and work with our staff there. I’m also on the scientific advisory board of the New Jersey Alzheimer Association.

Princeton Medical Institute, as we’ll talk about later, is the only New Jersey site that is part of the Global Alzheimer Platform, which is a national coalition of research sites of excellence that are doing work in Alzheimer’s disease. I’m also on the staff of Princeton Medical Center and involved in a lot of advisory boards and so forth.

Victor: Excellent. I didn’t realize it had been around so long. We have a very limited connection, which is that my very, very first job I was a pharmaceutical sales rep. It was at the time that they launched Celexa. I learned a lot about SSRIs, just enough to talk to doctors about it and take them out to shows.

That was back in the day where you could throw a lot of money at doctor to get them to write your scripts. I did that for a very brief time before I went to law school.

Dr. Apter: We were involved in most of the serotonin reuptake inhibitors research. Certainly, we were involved in Celexa. Even before it became part of Forest Pharmaceuticals, there’s a company called H. Lundbeck and company in Denmark which actually was involved in those clinical trials.

Victor: It was over in Europe that they developed the compound in force, and ended up licensing it and bringing over here.

Dr. Apter: Correct.

Victor: Yeah, that put them on the map. All right, let’s talk a little bit more about what’d be relevant to our audience. Make It Last is really focused on a retirement audience. More and more, we’re seeing, obviously, lots of dementia, Alzheimer’s‑related stuff.

Tell me, because you’ve been involved longer, is it more prevalent, or does it just seem like it because we can see more of the manifestations of what’s going on there? Has it always been as out there in term of cognitive issues?

Dr. Apter: Well, yes to both, it’s true. What we’re seeing is more recognition and diagnosis of Alzheimer’s disease. Alzheimer’s disease is really the plague of our century. We’ve cured malaria. We’ve cured polio. We’re getting better at treating cancer, but we’re not close yet to a treatment for Alzheimer’s disease.

The only way you can get a medication for Alzheimer’s disease that’s advanced is by participating in a clinical trial. What we’re seeing is an aging of the baby boom generation. People are living longer. In every country, especially in Western Europe, tremendous increase in longevity.

Of course, the baby boom generation is coming of age and reaching the threshold where Alzheimer’s disease is much more common. At age 65, you only have a three percent chance of developing Alzheimer’s. By the time you’re 85, you have an almost one on one chance, 50 percent chance of developing Alzheimer’s disease.

Currently, 14 million Americans have Alzheimer’s disease. By the year 2050, that figure will be almost 50 million Americans. We’re going to see an increased incidence of Alzheimer’s disease. It is really the major public health problem of our decade.

Victor: Why is it so important for people that are suffering and are suspected to be suffering from it to be involved in clinical trials? Are we still researching things that can treat and so we just need more people involved in that?

Dr. Apter: Princeton Medical Institute is the only Global Alzheimer Platform site in New Jersey. We’re part of this global coalition to bring a drug to market by the year 2025. If a drug is not currently in clinical trials, it’s unlikely to be approved by the year 2025.

Victor: Just because it takes so long to go through the process.

Dr. Apter: It takes so long to go through the process. There’s no drawbacks to participating in a clinical trial because you can’t get any medications for Alzheimer’s that are really effective unless you participate in a clinical trial.

The clinical trial offers people a lot of benefits. Number one it’s free. They see a board‑certified doctor at each visit. Where in America can you see a board‑certified doctor for free? They get MRIs. They get PET scans of the brain. PET scans can cost $3,500. This is all free. They get the follow‑up during the study.

Even if you’re not going to benefit yourself from the study, you certainly can’t do yourself any harm by participating. It’s actually good for the brain to participate in a clinical trial. There are several things you can do to improve your brain health. This is something that, at Princeton Medical Institute, we go around the state, we talk to community groups, retirement communities.

This afternoon, I’m giving a talk in Monroe, at one of the retirement communities about ways you can avoid Alzheimer’s disease or help yourself avoid Alzheimer’s disease. There are many things you can do. It’s not an inevitable thing. One of the best things you can do is participate in a clinical trial.

Victor: Where is the state of research for that? Are we trending positive to having something that’s effective by 2025? You’ve got your finger on the pulse more than anybody else.

Dr. Apter: I was just at the clinical trials and Alzheimer’s disease meeting in Barcelona last week. There’s a tremendous amount of research going on. The advances are really very significant. We’re working with several different avenues.

There are two important components of Alzheimer’s. One is the amyloid, which is the plaque. The other is the tau, which is the tangles. We were previously targeting drugs that target amyloid, but now, more and more, we’re realizing that targeting amyloid alone is not the answer. We have to target the tau.

There are two theories of Alzheimer’s disease. The people who believe in amyloid. We call them the Maoists. The people who believe in tau. We call them the tauists. Probably the answer is some combination of things. We’re also working with some plasma products because we realized that, if you can infuse some new plasma into patients, you may be able to regenerate brain cells.

We’re eventually going to be working with stem cells, genetic engineering. There are many things that we’re pursuing right now and it’s a very exciting field. We don’t have a candidate yet that’s looking really promising, but we’re working very hard on that. The science has really advanced a lot.

Victor: How early can someone get involved in clinical trials? We always talk about diagnosis that they say there’s mild, there’s moderate, and severe. Is there some point in time where it becomes better to reach out and be involved in clinical trials? Is there an earlier stage, a later stage? Are all stages available?

Dr. Apter: All stages are available, Victor, but the best way to participate is very early, and early detection is very important. At Princeton Medical Institute we offer free memory screening to anybody who calls or wants to come to our office.

We also go out in the community ‑‑ to retirement communities, to senior citizens groups ‑‑ and actually do the memory screening live for them in their own location.

Victor: Does it seem scary [laughs] at all? It may be an answer people don’t want to hear.

Dr. Apter: If you don’t know, you won’t be able to take part in the clinical research. It’s important for people to help also with Alzheimer’s research because one of the major reasons people participate in research is altruism, to help the field move forward. It’s very…

Victor: Even if there’s not something that they can do about their own situation.

Dr. Apter: Exactly. We’re moving the field of research earlier and earlier. We’re actually doing studies now on people who don’t have Alzheimer’s but may be at some risk for Alzheimer’s. We call those prevention trials.

For example, we’re doing some studies in Columbia, South America, where we’re taking families with a high genetic risk of Alzheimer’s disease that have an autosomal dominant gene for Alzheimer’s disease. We’re trying a medication in these family.

We’re giving the drug to people who have the gene and people who don’t have the gene because we don’t want to unblind who has the gene and who doesn’t have your gene. These are long studies. These are studies on people who don’t yet have Alzheimer’s but may be at high risk. Many studies are now underway.

At Princeton Medical Institute we will have some of these studies coming in the future. We’re just trying to identify a drug that will be best for these studies.

Victor: You made mention about a gene marker in there. Is that the thing that puts the person at highest risk for developing Alzheimer’s? Is it that plus a combination of a hereditary, some form of a history of it?

Dr. Apter: There are family histories. The family history may be a predisposing factor. Having the APOE e4 gene. You can get the APOE e4 from both parents. You have twice the risk of developing Alzheimer’s disease. If you have the APOE e2 to from both parents, you have a 50 percent lower risk of Alzheimer’s disease. There’s also APOE e3, which is an intermediate risk.

There are also some families ‑‑ as I mentioned, these families in Columbia ‑‑ that have another gene. A presenilin gene that actually imparts a much higher risk of Alzheimer’s disease. The main thing and what we’re promoting at Princeton Medical Institute and through the global Alzheimer platform.

If anybody’s interested I would suggest going on memorystrings.org and finding some things that can be helpful as far as finding a research site, number one. Two, things that you can do to improve your mental health.

There are many things you can do. These include exercise, brain health, learning new languages, challenging your brain, diet. We found that people who eat a specific diet have a lower risk Alzheimer’s disease such as the Mediterranean diet. People who are engaged socially a lot have a lower risk of Alzheimer’s disease. There are many things that may lower your risk of Alzheimer’s disease.

Victor: One of the things that I did over the last year is lose about 35 pounds by switching to a largely ketogenic diet, but also trying to get away from those free‑floating sugars and a lot of the insulin stuff that is, what you were mentioning, really linked to some of the risk factors for developing Alzheimer’s.

There’s this pre‑diabetic conditions. A lot of these things are related to that, at least in the research that I’ve seen.

Dr. Apter: Exactly. The what’s good for the heart is good for the brain. Keeping blood pressure under control is very important. Keeping your blood sugar under control is very important. Keeping other risk factors under control is very important. All these are things that you can work on to help your health, both mentally and physically.

Victor: Let me shift gears a little bit and say, if there’s somebody that’s already suffering from Alzheimer’s, do you have a set of recommendations for how either to suffer through it with less trauma, ease the decline, something that would be from that moderate stage on that you see as a good set of activities to help them engage in for that?

Dr. Apter: There are several things that they can do, like music therapy, meditation, yoga. Being on a medication that may help. There are medications on the market and we did the studies originally like Aricept and Namenda. People can be on those. That may be helpful. We were also looking for some symptomatic drugs that may be an add‑on to Aricept and Namenda.

When I say a symptomatic drug, we’re talking about drugs that improve memory such as Aricept and Namenda, but, after a while, those stop working. We’re working now with some add‑on drugs that may help with memory in the short term. The most important drugs that we are working on are those that delay the progression of Alzheimer’s disease.

There’s nothing on the market that can do that. That’s why people who may be interested in a clinical trial and provisional progression of Alzheimer’s disease should give us a call and come in for a screening.

Victor: OK, great. We’re talking specifically about the Princeton Medical Institute and reaching out to them for clinical trials. What is the contact information? Do they go to a Web site? I’ve been on there and there are forms that they can fill out. Tell us a little bit more about how can they can directly engage with it?

Dr. Apter: Everybody should see us as a resource. You can call us even if you’re not interested in that clinical trial. We can give you information on support groups. We can give you information on Alzheimer’s disease, on medications. Our phone number is 609‑921‑6050. That’s 609‑921‑6050.

Our website is www.princetonmedicalinstitute.com. As I mentioned, there’s also www.memorystrings.org, where you can find brain health activities, suggestions, diet, exercise. We are a resource, so anybody who’s interested, please give us a call at 609‑921‑6050. Our office is on Bond Drive in Princeton, located near the Princeton Shopping Center. Very convenient.

We also partnered with the Lyft to provide rides for people who can’t get to our office for clinical trials. Really, that’s very important, as that people be able to come in to our office. We do require that they have a caregiver. That can be a family member, it doesn’t have to be a family member.

Just somebody who spends some time with the patient. The FDA requires some input from somebody who’s involved in the global activity of the patient such as their washing, cleaning, hygiene, and their daily activities.

Victor: That’s fantastic and that probably is so commonplace. By the time they come and see me as an elder law attorney, they’re already in the situation where they’re trying to deal with this, and so there is an existing caregiver that’s there.

I would say, just experimentally, people are unaware of the opportunity to be involved in clinical trials. The more that we share that information, not only do they have a chance of improving what they’re doing, but they can contribute to, generally, the better results for everyone if we can find some more information out.

Dr. Apter: Yeah, my colleague, Dr. Joyce Kramer at Yale, wrote a book on clinical trials. She said the best medical care you can get in America is through participating in a clinical trial because you get frequent blood work, EKGs, pet scans, MRIs. We can share those results with your own doctor, your neurologist. We don’t compete with them. We try to collaborate with them really well.

Victor: It doesn’t take the place of the course of care that’s being treated by the neurologist, whoever the specialist that’s working with them. It’s just an add‑on to what’s going on?

Dr. Apter: Yeah, and a lot of our referrals come from neurologists who are stumped about what’s the next step. They often recommend a clinical trial for patients.

Victor: That’s fantastic. I want to thank you for joining me, doctor. This is a resource that I think everyone should take advantage of. I agree with you, just from my limited standpoint, that Alzheimer’s is the most threatening disease state that is facing the general population.

My mom is being treated for lung cancer now and the treatments that are available, they’re wide, they’re broad, they have got lots of things in there, but, other than naming two drugs that are available for Alzheimer’s, there really is nothing else.

I want to encourage all of our listeners to reach out to the Princeton Medical Institute if you are either in a situation where you suspect that you have Alzheimer’s or you’ve been diagnosed with it, or, as Dr. Apter mentioned, more of the preventative trials that might be there.

Any state that you’re in, reaching out to them and seeing if you can participate in it because the best thing that can happen is you can find something that is effective. The worst thing to happen is nothing. There’s nothing bad that can happen to you for participating in it.

Again, why don’t you just give us the phone number and the Web site for people to reach out to?

Dr. Apter: Our phone number is 609‑921‑6050. That’s 609‑921‑6050, and the Web site is www.princetonmedicalinstitute.com.

Victor: Thanks for being my guest today.

Dr. Apter: Nice to be here.

Victor: That was our interview with Dr. Apter. Again, pre‑recorded. Dr. Apter does have a very busy schedule so we want to thank him for being our guest today. Incredibly useful information if you’re ever in a situation where you’ve got Alzheimer’s or you’re suspect to have Alzheimer’s. They even deal with depression and PTSD.

Reach out to the Princeton Medical Institute and see if you qualify for some clinical trials. Nothing bad can happen. Only good things can happen from that. I want to thank him for being our guest.

Again, if you like this show or you find this show to be particularly useful, and I think that you might, if you know somebody that’s going through, this the best thing you can do is share a copy of this. Get somebody to subscribe to it.

It’s available on iTunes, Spotify, anywhere that podcasts are available. You can go to makeitlastradio.com and go and download this episode or send somebody the link.

We’ll be back next week. We’re starting in the holiday season. We’ve got a few guests that are going to be joining us. Again, I’m following on this theme of what happens when families gather and we noticed that we need some help along the way.

I’ve got a couple guests that are coming on in the next few weeks that are going to help share that additional information. Other than that, we will catch next Saturday here on Make it last, where we help you keep your legal ducks in a row and your financial nest egg secure.

About Victor Medina

Victor J. Medina, managing attorney of Medina Law Group, devotes his practice to estate planning, helping parents and grandparents to leave their wealth to whom they want, when they want them to have it, and in the way they want.